AAPC Reimbursement Methods & Fee Schedules

Question 1

What is a fee-for-service (FFS) reimbursement model?

Accepted Answer

Paying providers for each individual service or procedure performed

Answer

In fee-for-service, providers are paid a separate fee for each service rendered, incentivizing volume of services rather than outcomes.

Question 2

What is capitation in managed care reimbursement?

Accepted Answer

A fixed per-member-per-month payment to a provider for all covered services regardless of utilization

Answer

Capitation pays providers a set monthly amount for each enrolled patient, regardless of whether that patient seeks services.

Question 3

What is the Medicare Physician Fee Schedule (MPFS)?

Accepted Answer

A payment schedule that determines how much Medicare pays physicians for covered services based on RVUs

Answer

The MPFS establishes payment rates for services provided by physicians and other qualified professionals under Medicare Part B, calculated using relative value units.

Question 4

What does a relative value unit (RVU) represent in physician reimbursement?

Accepted Answer

A numeric value representing the work, practice expense, and malpractice components of a medical service

Answer

RVUs quantify the physician work, practice expenses, and malpractice insurance costs associated with each service, forming the basis of Medicare physician payments.

Question 5

In the Medicare Physician Fee Schedule, what is the 'conversion factor'?

Accepted Answer

A dollar amount multiplied by total RVUs to calculate Medicare's payment for a service

Answer

The conversion factor is a national dollar amount set by CMS annually that, when multiplied by the total RVUs for a service, determines the Medicare payment rate.

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

(AAPC) American Academy of Professional Coders Biller Certified Practice Test

AAPC Reimbursement Methods & Fee Schedules